Unpublished novel by Rakesh Biswas for all interested in the science and fantasy of medicine. Not about religion, but a postmodern multi genre combining elements of Science, Fantasy and Romance
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The inoculated system

 

Mr. Godwin Simon sat waiting his turn at Professor Mechanic’s liver clinic with a worried expression displayed on his LCD screen. His blood tests suggested that his system was infected with a bad virus that was possibly fast damaging valuable files on his hard disc. One of his friends had recommended Professor Mechanic’s liver clinic and he was quite hopeful and yet couldn’t stop worrying. Also he was feeling a peculiar heaviness in his lower limbs especially since last night after his wife noticed they were swollen. That was definite sign of a promising future system trouble, the very thought of which made him even more depressed. This was on top of the fact that his business hadn’t been doing well lately. The sweet shop he ran was affiliated to a popular brand, “Slurp”, with a chain of monoclonal outlets around the countryside. Recently the company had suddenly decided to close down countrywide (although his particular shop was selling well). There was some story about the son in law taking over after the owner father in law’s death and selling his company off for a better business nearer to his own heart. Godwin had no immediate options but sell sweets from local small time sweet manufacturers in the country. His customers who relished the “Slurp” brand didn’t take kindly to the fact that Godwin was still using the name “Slurp” in the neon sign outside his shop (originally provided by the company who didn’t bother to reclaim it) while selling unbranded non media hyped local goods (which Godwin personally felt weren’t less tasty). Godwin was angry at “Slurp” for having ditched him and other “Slurp” outlet owners who were making reasonable money to feed their families, angry at globalization for having given birth to “Slurp” in his small town business that was otherwise getting along fine without it before it came along with promises of slurp-more (slurp-plus) money. His anger was soon quelled by fear, the fear of not finding another suitable ‘slurp’ or ‘burp’, the fear of resulting penury, eviction of his bright child from the local good school due to non-payment of fees, having to resort to selling his wife’s jewelry and now this virus. He felt his system crashing along with his whole world coming to a hanged standstill. Professor mechanic informed him that the virus had already made sufficient forays into most areas inside his liver, systematically destroying each and every hepatocyte file. His leg swelling was due to an excess fluid in between the cells in his leg. The interstitial ocean showed up as edema due to an excess fluid of three liters inside his Earth. There was excess fluid also inside his belly, in the peritoneal bag covering his intestines along with other organs like the liver inside his abdomen. This flood of fluid explained professor Mechanic, resulted mainly from a fibrosed liver with blocked inlet pipes because of repeated inflammation and healing around its microscopic hepatocytes all stimulated by an idiotic hitchhiking virus. Hep-B, the professor called it (a bit rather too affectionately thought Godwin). It also struck him odd that Professor Mechanic should say that the virus wasn’t responsible in itself for the destruction of his hepatocytes. It was his own system’s immune cells that were responsible for all the carnage as they went on a trigger-happy shooting spree burning off all the hepatocytes in their attempts to target Hep-B.     

 

The Letter from a virus 1

 

June found Mr. Godwin very polite and co-operative soon after his admission to the ward, inspite of the fact that he was obviously depressed. On doing a physical examination she found his limbs swollen along with the fluid in his belly. This was removed by her senior for testing to confirm that the fluid was all due to an increased pressure in his liver. That night Mr. Godwin couldn’t sleep well.

He woke up next morning to find June at her bedside. He was feeling groggy and she seemed to be asking him to keep his hands extended from his wrists for some time. He wondered why one would want him to do that. Nothing seemed to be making much sense any more since he had been admitted to the hospital. Last night he had received this letter from the virus that was supposed to be habiting his system, which from the virus’s microcosmic perspective seemed a huge universe of its own.3

 

Dear Godwin,

 

I am a Hep-B virus amongst the now countless many inside your system liver. It is a desperate attempt to reach out and communicate a tale of our life long struggle in a community hated and hunted from its very inception. The present state of affairs is such that we are nearing a perishable climax but more importantly, we seem to be dragging down your system the body of Earth as well.

We were originally a tribe of fishermen living off the ocean, in the west coast of a huge landmass of Hepatocytes. Our earliest settlers had arrived on its shores long back and a strange tale of their appearance has passed down verbally over generations. They claim to have frequented a similar planet, with oceans, islands, palm beaches and plenty of fun and frolic. Once, on a yachting trip, his majesty, the HBV virion along with HBeAg and HbsAg, two of our ancestors (at that time probably in their teens) rode the waves a trifle bit longer than usual until the main land mass of Hepatocytes grew smaller and smaller, at a distance. There was a dark orange hue to the sky as the sun left an uneasy calm. It all began at that moment when both of them prepared to tackle a rather gigantic wave approaching and lifting them up. It became larger and larger, assuming proportions of a gigantic mountain.

Preparing to meet death, they suddenly found a huge steel tunnel piercing the sky and descending on to the ocean. They watched open mouthed as the gigantic tube sucked all the water along with them into its claustrophobic insides. It was, as if they were swept into another dimension and some of us wondered if it was a near death experience. After, a time, there was another gush of water from the other end of the tunnel, probably water being emptied somewhere, thought HBsAg as he hung on to the sides of the tunnel with all his might.

Before, long their tunnel pierced again into another good old three-dimensional earth and as soon as it touched the ocean, our boys started swimming for dear life. This time there was no suction vortex and they managed to swim over to a similar landmass of Hepatocytes. It was a complete virgin land in those days. None of the gory sky scrappers you see in the present concrete jungle. There were lush green fields bordering on dense forests, a hut or two, a fire to keep you warm for the night and that was all the smoke it produced. Not like the smokes of presently upcoming power plants.

 

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Letter from a virus 2

Our ancestors arrived like Columbus and started knocking on the doors of the native population which resided peculiarly deep within the earth in a nucleus. Our ancestors might have opened a hidden trap door and descended down an escalator to a huge sphere with multiple small windows. Clothes weren't allowed and so his majesty, took leave of HBsAg and HBeAg, shed off his royal robes and climbed into the sphere, as naked as a DNA. There, he was greeted by the local chromatin population and shown around.

Great place! Thought the king and settled down, had children, another life, and another kingdom. Now we Hep -B viruses don't enter into sexual relations that easily but prefer to replicate our own DNA, so the king sat to meditate. His deficiencies and gaps were filled and he became a covalently closed circular DNA (or you could say he was totally covered up in a termite mound). The CCC-DNA was extruded out of one of the windows and then the mound broke into three pieces of slithering snakes, ready for transcription. It proceeded with the synthesis of a minus strand followed by a plus strand and finally we had baby HBVs.

The first threat of an external aggressor appeared around this period. It wasn't anything to do with the natives within the nucleus who were pretty docile and never troubled us. It was the ocean predators.

They were probably the other inhabitants of this vast body of earth in areas, which still remain unexplored. They started off by attacking our children. Dear little baby peptides dressed in colorful epitopes loved playing in the beach. We never thought they would draw the attention of those detestable classes of MHCs. They would play with our children and hold them up in the air from time to time. Little did we know that this would be a signal for their CD-8 (seedy-ate) ally that is until the first bombardment.

The hepatocyte shores went up in flames. Fire spread rapidly, lighting up the usually dark jungle silhouettes. Across another corner, in a dim glow, one could barely discern other dark shapes getting down from odd looking boats, starting to drill the earth with perforin drillers and pouring poison into those drilled perforin channels .

The ravages we have survived along with our coveted land are a tale often repeated. I guess, every society has its persecutors, bombardments and yet life begins anew. Many of our brothers devised increasingly cunning ways of eluding our seedy attackers. It’s been a topic of research among you humans (some of us refer to you as Demons/Gods).

Mechanisms of persistence of Hep-B viruses in chronic carriers, is a hot issue, the complete unraveling of which might push the final nail into our coffins. However, before that I seriously believe and wish to convey that your body of earth itself is in jeopardy.

 

 

Letter from a virus 3

 

 

 

Mechanisms Of Hbv Persistence

 

 

Some of our HBV brethren left the hepatocyte shores and swam with the strong oceanic currents to seek refuge in other greener pastures...kidneys, brain, testes, pancreas and the like. The seedy cells couldn't pursue them all the way to these places apparently dissuaded by micro-vascular anatomic barriers, which surprisingly are lacking in the Hepatic sinusoids. Other than this, some of us tried to fox the MHCs by mutating the epitopes in our babies to evade recognition by seedy eyes. Then there were some peculiar natural factors, which came to our rescue as well. The MHCs we learnt were essentially polymorphic and all MHCs were not equally bad and some of them just played with our kids. The MHC II came perched on macrophages and these giant whales required a daily rubbing of Vitamin D oil on their surface, to actually stay active.

Recently some of your people discovered a mutation (T to C at 352 position) in the Vitamin D receptor gene that might lead to inadequate activation of these killer whales. These whales also love to eat with a particular sauce (mannose binding lectin) and again this was successfully adulterated. Another ploy that we had to devise was born out of sheer desperation in our continued struggle against the seedy cells. One night, hordes of our guerilla forces attacked a fleet of passing PBMCs (peripheral blood mononuclear cells), climbed onto their ships and took over after a bloody battle. Their wireless system with which they used to summon more and more seedy cells were effectively silenced.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Letter from a virus 4

 

 

Carcinogenesis

Other avenues of survival opened up in our very homes inside the hepatocytes. The local people we noticed were surprisingly immune to seedy attackers. They had disagreeable features but in the interest of survival we started marrying into their communities (effectively, integrating with our host genomes). We married and multiplied into a modern cosmopolitan society. Gradually, we lost our food gathering nomadic existence and settled into concrete stable dwellings with equally fine-processed food to satisfy us. Multi-storied buildings started adorning our skylines. Gone were the palm trees, green fields were encroached by collagenous cement that hardened with each passing day. You could almost hear the muffled cries of earth as it stifled over this new overpowering burden.

Since the early part of this century ...we had continued to rebuild and regenerate after each and every seedy attack. However regeneration and degeneration can leave ugly scars. Presently we have had the unfolding of another interesting scenario. The seedy missiles having been silenced, what we have now is simply growth and more and more growth.

Some of us have begun to see through all this growth and realize our days as well as that of the earth are numbered. It's only a matter of months now. That is, if we can't devise new ingenious methods to escape our present predicament. Life is generally defined by some universal traits, which we suspect might be present even in you humans. It might be present even in the myriad subatomic particles that make up our relatively puny bodies.

 

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Letter from a virus 5

The earth which we live in seems similar to your earth and we are accumulating enough evidence (partly through internet) that it’s inside you humans where we might be residing (like your concept of a living earth). Therefore, this uncontrolled growth of our civilization might be the death of your body and therefore this desperate communication (By the way, is the growth of your society too progressing exponentially - really, this concept of parallel universes is fascinating).

Life grows as an expression of its universal traits, chief among which is a perennial dissatisfaction with the present and an insatiable urge to change, replicate and evolve. Look at our evolved bodies, added up from myriads of subatomic particles and look at your body (our earth) even more highly evolved and yet yearning for more. More love, more growth, more reproduction both in thought and form ... yet survival is the name of the game and we have evolved over the years, just to survive. I am confident some of us will manage it even in the wake of this global cancer.

As night falls, a few dark silhouettes among us have been noticed to wade out with their rubber dinghies into the deeper waters of a darker ocean, hoping against hope.... someday ... another tunnel, another universe, fresh green rice fields bordering dense forests. Clouds you'll notice, too exhibit living characteristics of a non-linear replication, summation and accumulation, which from time to time, bursts into a downpour, catching you unawares in the rain. We wanted to live like a cloud but ended blowing up in smoke.

Yours truly,

Hep-B alpha

Godwin had suffered a blood vomit that very night of his first day of admission and in the morning he was found by June to be a bit drowsy. He was in a confused state and June found his hands flapping when he tried to obey her request for keeping his hands extended. An ultrasound examination that very evening he got admitted had shown a tumor in his liver. Mr. Godwin died the following day, mercifully saved June thought from all the treatment that would have followed if he had survived. Godwin’s elder brother had come to take his corpse and on his request she removed some of the fluid from his lifeless belly as that definitely made it lighter and easier for them to carry.

 

 

 

 

 

Hunger for food and air

 

June now in her 7th semester is posted in the tuberculosis ward of her hospital right in the heart of the city of Kolkata, a heterogeneous mix of complex systems animated and inanimate alike. She gets to meet a lot of patients every day adding to her narrative database now rich with innumerable patient anecdotes. She sits at the bedside of a lady and tries to start a conversation by asking the usual what is your problem and gets a well-framed morphologic and etiologic diagnosis as an answer, instead of the usual symptoms often narrated by patients. The lady clarifies that she is a physician, a former student of this college and now admitted as she has developed tuberculosis on top of her newly diagnosed diabetes. As she talks with June her mobile phone rings and June gets a feeling from her telephonic conversation that she must be a successful general practitioner. “It’s quite trying you know to remain in a hospital bed while you have a busy patient practice.” June wished she could be like her in the near future.

She continued her patient interviews and was taken up by another lady who appeared pale and yet cheerful as June approached her. She had been diagnosed with tuberculosis long back 10 years ago she said when she was just 25, that was a few months after her marriage and her husband had left her in the village to come to this city in search of a job and never returned since. She had lived off her parents and brother for a while but had to leave them too eventually, as they couldn’t bear the cost of her treatment. She took up the job of a sweeper in the local health center in the next village. She learnt quite a few medical things there as the doctors and paramedics in the center would use her as an all purpose help and village patients soon became used to her sweeping the floor of the clinic and at times dropping the broom for the hypodermic syringe that she would stick into their posteriors with equal élan.

On doing a physical June discovered she had an increased breathing rate more than normal and there was a peculiar caving in of her right side of upper chest. The sounds too of her breathing that she heard in that area of her chest were definitely not normal. They were more of hollow, tubular rather than the normal soft rustling. Even tapping on that area with her fingers produced a dull sound rather than a resonant note. She could also see that the big air pipe into her lungs and her palpable heartbeat had shifted to the same side as the caved in area of her chest. She asked the other lady doctor in the room about what morphologic diagnosis that would suggest and she said, “Looks like a right upper lobe of lung collapse possibly due to fibrosis as a result of her old tuberculosis.” As June got ready to leave, the patient suddenly asked her if she could request the hospital authorities to ask the kitchen help to give her a little more rice in her lunch as she felt so very hungry even after finishing off whatever they provide. Looking at the surprised expression on June’s face the lady doctor laughed and said, “These poor patients never get enough to eat. The food they give them is horrible and yet they hunger for more. Actually the government has sanctioned enough money for good and adequate food for them at each meal but half of it unfortunately makes its way into the neighboring restaurants sold off by the hospital kitchen staff who have a shady liaison with them. This is our country, as physicians we can only practice and make money but we can’t have our own sincere research. We leave the research to the West, as we don’t have enough to eat. Fly off to US if you get the chance.”

 

 

Airways opening into system-rivers

 

Professor Mechanic resumed, “Approaching patients with disease in the lung and the bags covering it can be tricky as well as easy at times. The lungs can collapse like punctured balloons either due to an obstruction in its air pipes, the air in it getting absorbed by its rivers or they could cave in due to fibrosis that follows any inflammation. The balloon like air spaces inside the lungs can be filled with pus due to infection or they may develop tumors. I shall take you to the Lung wards where we can meet an assembly line of systems with afflicted lungs in all its variety. You see this 35-year-old lady she has a caved in right upper chest with a dull note on finger tapping and a breathing sound that is hollow tubular…Collapsed right upper lobe due to old tubercular fibrosis. This 25-year-old girl with wheezy sounds from her chest and breathing difficulty has a spasm in her airways because of an inflammation there again stimulated by her system immune cells responding to foreign particles. This 50-year-old smoker has just the opposite of what you saw in the 35-year-old lady. He has a bulge in his right upper chest instead of a caving in but then the dull note on finger tapping and the hollow tubular sound are also there. This patient has a tumor within (what we call a morphologic diagnosis of right upper-lobe lung mass).

 

Post modern post bed-side student conversation 

 

Tap-tap the back of this patient on his right, a golden backed woodpecker hammering on an old oak tree…Sounds normal eh! Tap-tap the front of his chest…um…sounds dull on the right upper part, the distant thud of a woodcutter at work, deep inside a dense forest. Now place your stethoscope on its back, the gentle rustle of a summer breeze traveling through pine forests bordering on moonlit sands. A normal vesicular breath sound right! Now listen to the dull area you just tap-tapped. Uh! Oh! A bunch of jungle babblers engaged in furious conversation. What does it look like? Um…fine discontinuous high-pitched crackling sounds. More like firewood sputtering eh! Possibilities are, right upper lobe fibrosis due to old tuberculosis or right upper lobe collapse due to an endo-bronchial growth with post obstructive pneumonia. Wait a minute! What’s that growling sound?

Aw! Gwan…I remember the fright you gave me in Ranthambore! It turned out to be only just an insect and not a tiger after all. I am sure…I’ll be…there’s definitely something in there…deep down…maybe. Oh well, we do know that lesions deeper than 5 cm within the lung may not be audible. Could it be a solitary pulmonary nodule? Never heard of it producing such a sound, a solitary hermit perhaps deep inside a forest, engaged in conversation with a tiger.

 

 

 

 

 

Moving muscles and stories

 

 

 

June was waiting in the hospital corridor for her case to be allotted when she suddenly noticed an interesting machine walking in a peculiar manner with his limbs snipping the air between his thighs like a pair of delicate scissors. He didn't seem to be in much of an agony but did have difficulty in dragging his stiff limbs. June knew this had to be an electrical problem and eagerly followed him to his bed.

"Machine movement, began Prof Mechanic, is primarily due to muscle cells attached like flexible bands over the rigid skeletal rods termed system bones and with each and every electrical stimuli there is a contraction of all these muscle cells that make the flexible bands contract producing a torque to the skeletal rods, resulting in movement. Movement could be impaired due to either the muscles drying up on their own fashionably termed myopathy or due to improper electrical firing into the muscles. If the current flows through them too much it causes the muscles to go awry resulting in stiffness of the limbs. This too much of erratic current could be due to a loss of inhibitory signals from the ICs in the spinal generators because of damage to their wires (fashionably termed the upper motor neuron, which indicates their source and distribution). The wires of the upper motor neuron start from cells in the cerebral cortices, which most machines carry in a skull casing that also houses its own LCD display at the front, termed face, replete with more muscles and finer circuits for facial expression. The same wires travel through an internal capsular area and the brain stem inside the skull, in pyramidal bundles and finally reach a station labeled "Anterior horn" where the upper motor neuron train stops. Another bunch of neuron wires called the 'lower motor ' take off from there and reach all the muscles in the human machine. As current increases in upper motor wire damage it leads to a chaotic state of increased muscle contractility making them spastic.  Lower motor wire damage has the opposite effect and makes them flaccid and limp. The machine is hardly able to move a muscle at all. A galvanometer testing the muscles would register no current. With time the muscles atrophy and the limb is just a rod."

 

 

 

 

 

 

 

 

 

 

 

 

 

Possibilities Jumping and quivering

 

 

June followed the young man to his bed with her galvanometer which was this plastic thing resembling a hammer. He was a bright boy preparing for his pre-meds and had topped his class in his village schools up in the mountains of Garhwal.

His muscles didn't look wasted at all. His muscle power wasn't that bad either, in fact it nearly equaled June's own as she asked him to flex his elbows but then on striking his muscle tendons in his upper and lower limbs June found them jumping and quivering. It was evident that the current flowing through them was quite strong but obviously misdirected due to malfunctioning ICs in his spinal generators. Somewhere in the thick bunch of wires especially as they ran in the area of his spinal cord at the back of his neck (termed the 4th cervical segment) was the lesion (the morphologic diagnosis). What was it that was disrupting the ICs there? Was it a tumor? (Unlikely, the machine had almost grown up with the malfunction). Was it the skeletal vertebral casing compressing the ICs causing cord dysfunction that was something treatable? Again looking at his back June couldn't find anything wrong with his vertebral column. Was it some blood pipe to the spinal circuit that had got blocked, drying up the ICs? Was it an inflammatory demyelination, a condition where the ICs lose their myelin sheaths (they help the current flow, jumping saltatorily over their nodes of Ranvier)? Unlikely again because both would have had an acute onset and the latter would have shown signs of recovery as soon as a new sheath replaced the old one in the ICs of the cord.

It looked more like as if the cells forming the ICs in the spinal cord had died on their own, a process termed apoptosis, which might have been triggered off by an external event, the entry of an email virus or may have been a consequence of a genetic software program inbuilt into his operating system.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Seems as if it was just the other day

 

Kris noticed June for the first time in Samsara's akhara during the winter festival in Bolpur, a place enriched by the past of India's poet laureate, a university not very far from Samsara's own at Sushunia. Kris had simply gone to Samsara's Akhara out of curiousity.  He wondered how a professor of anthropology masquerading as a Baul would look in person; however it was the professor's daughter who caught his eye and tugged at his heart. Juneli Sen he knew had topped that year’s prim school living certificate exams among numerous students who had appeared. Krishnadas Mitra hadn’t done too badly for himself but topping the list was like a wild dream. Everyone had complimented Samsara adding that his daughter had inherited her father's brains. In his hard disc inoculated with Baul spirituality there were areas that still responded to ego titillations.

Kris spotted June with her father singing the Baul songs he loved. She had a strong voice that seemed to have been well honed in Indian classical. They were flanked by Samsara's students who were also eyeing June. Kris didn't know how to approach her. She had this long hair in plaited braids and a smile that melted Kris. He wanted badly to know more about her, talk to her and then suddenly it all just happened. Samsara had begun singing and as the audience reshuffled he found June squeezing in beside her both of them sitting crosslegged on the floor with one of June's knees snugly nested against Kris's thigh, both hidden behind a thick layer of Sari and trousers.

It was June who spoke first. "Are you an Engineering student?" Kris gulped (only momentarily), "Well no. I am Krishna, my friends call me Kris. I have heard about you and it’s a great pleasure meeting you this close."

As June and Chris walked into the moonlit night they crossed the Saal Bithi , a small forest of Sal(scientific name?). June had particularly requested Kris to accompany her through this forest to her hostel gate, as the forest didn't just have trees. The trees watched them, protector and  protected as they walked side by side, their hands just brushing each other, as if not daring to do anything more. God had never experienced anything like this before with his machine. Love was in the air knocking at the doors of Consciousness (God for short). What was it in the physical appearances of their machines that attracted them? Was it the way June smiled, her dimples creating a bewitching exterior? Was it in the manner Kris carried himself, the dreamy look in his eyes promising a great future (that was at present hidden in his side bag manifesto). They talked of all sorts of things under the stars and the Sal (scientific name?) and knew not when time flew or hopped from tree to tree just to cover that short distance from the fair grounds to June's hostel.

 

 

 

 

 

 

76

 

Like a whiff of rain swept Earth

 

After the secondary school leaving certificate, which June topped there was this higher secondary school leaving certificate that needed to be topped and Kris was healthy competition. Both would meet more often exchanging notes, differential calculi and physiology of the cockroach amidst a few unconventional write ups that June would pen down from time to time in her diary, again a legacy inherited from her illustrious father.

 

June’s diary

 

Dear Kris,

Sometimes, it seems as if it was just the other day you turned up suddenly out of the blue,   gave us a pleasant surprise. Remember…the roller coaster ride on top of a rainbow, stopping to chat with a flock of geese returning, sleeping awhile on soft cumulus clouds.

You’ve been away for long yet, now that its time for sunset, the stars seem to lie in wait for someone, before they start peering out, in countless dazzling millions. If you could manage some time do visit us soon. Long since we bathed together in the darkness and quenched our thirst on the other side of the moon.

 

Kris’s note:

 

Dear June, You stepped into my dream, like a whiff of rain swept Earth. A cool breeze blew through the windows while the rain…created music outside. The room bore your silent eyes and me lying on the mat. From an unearthly distance you bent down and breathed softly into me, while I …kept on struggling to reach you, through dense jungles, steep slopes, gradually you receded into that never ending corridor.

The results were out and June had topped again this time securing admissions into most of the prestigious Medical and Engineering colleges in India. Kris hadn’t done badly for himself either and had been lucky enough to get himself a seat in a medical college in Kolkata. June left her seat in the prestigious central institute for Trouble shooting humans in Delhi just to be with Kris. The distance from Sushunia to Delhi wouldn’t be cost effective if she had to come and visit them once a month, she told Samsara. Samsara was anyway overjoyed and heart broken at the same time. Joyful for his daughter inheriting his brains and saddened that she was joining the very subject he loathed. However he had decided he would let her make the choice rather than decide for her as his parents had done for him decades back and ruined his career. “I thought my daughter would have made an intelligent choice but no she had to become a doctor knowing very well the soup I had landed myself in.” Maya comforted him, “It’s possible that she wants to avenge your failures in medicine.”

 

 

 

 

 

Eeeeek, or should it be mmmmmmmmmmf...I sniff some pain, a deep breath or two.

 

 

 

June and Kris pass their medicine finals and June is expectedly at the top of the list. Both start their internship enthusiastically. However, June notices Kris gradually starting to ignore her. One day Kris discloses his plans to go to US for which he's being financed by a mysterious uncle. June can't afford it herself. Samsara with his meager professor's salary can hardly cater to all the demands of Maya and Dupki, her younger brother. Also money would be needed for her brother's engineering school and Samsara's Baulish antics were far from paying. June would have just loved to go to US. If only Kris would have offered to look after her there, but no he was being very secretive about his uncle in US who wanted to see him there alone. Most of June's class acknowledged that even if one single person was to score the highest in the US medical licentiate exams it would be June, given her marvelous track record. June had to stay back and see off Kris at the airport with tears in her eyes and she had a feeling she would be seeing him for the last time. One of her friends generously volunteered the information that Kris's mysterious uncle sponsoring him in US was actually his would be father in law.

 

The Indian Institute of Trouble-shooting-humans(IIT), post graduate entrance exams were the toughest in the country not only because it was an institute of national importance with all Governmental grants directed towards it, that made it highly covetable but also because of a system of in house reservation for students who had already graduated from that institute. Off course they had only been able to do their graduation from there because they had cleared another tough entrance exam at the pre med school level, the one that June too had cleared but had forfeited in preference to studying at medical college, Kolkata, just to be with Chris. Now that Chris was out of her life, June was free to try out her luck again this time at the IIT for gaining entry at a post graduate level. June never needed much luck. Or is it that she was lucky to have got such marvelous brains. A photographic memory allowed her effortless data storage in her hard-disc with an infinite capacity. In addition a super fast clock speed with a very high random access memory allowed her effortless data retrieval. If life had been hard to June in matters of heart it was extra kind to her brain. She was relieved to see her name in the merit list right at number one. Relieved not only because she had something good to fall back on (if not US) but she was also going to get a good stipend as a post graduate resident. This would also allow her to sponsor her brother's undergraduate engineering school.

 

 

 

 

 

 

House plants cruising through summers bliss

 

June decided it was time for her to chill out and relax on the system trouble-shooting after all, things were not that dim for the future. She had a secure job as an MD resident and there was a saying about the institute that if one just managed to keep one's eyes and ears open while working in the hardware lab located in the wards of this teaching hospital, knowledge would seep in from its walls. These walls would nevertheless confine her in their midst from 7 AM to 10 PM. It would also float in the fresh cool air in the institute gardens (on rare free Sundays) or the hot air in its canteens (where heated lunch and dinner time discussions would manage to keep the food palatable). She met Seshu in one of those rare picnics that had been arranged by the Gynecology department. The bus took them to a place near Delhi called Barog, a beautiful hamlet near the Himalayan foothills. Seshu was quite lively, singing and dancing whenever given the opportunity in impromptu picnic sessions. June found an empty chair beside Seshu at dinner time in the bungalow like hotel and Seshu immediately struck up a conversation. Other residents eyed them knowingly as June appeared to be getting quite taken in by Seshu's advances (the picnic was a success even if it just managed to pair up a single couple). They were two separate departments and June could meet him only during meal times in the canteen. Seshadri Srinivasan looked jubilant on meeting her each day and they would talk on a variety of topics under the sun. June liked him but...there were too many buts and the important ones off-putting about Seshu was that he was a Tam Brahm (even if he wanted his parents wouldn't agree) also he was much too fast and ethereal. Krishna's wounds were yet to heal, although Seshu did provide the much needed balm. Predictably Seshu proposed (a steady relationship) by the end of the month and was sweetly turned down by June to which his predictable response again was, "We could still be friends." Far from it he quickly started chasing other girls in the campus. He had once confessed to one of their common friends that having a good time with girls was like a train he was afraid he might miss if he was too late...time was running out for him and so was life. He had to part ways with June just to be on the move.

June let the rigors of residency wrap her up like a cloud covering a blue mountain and bathed daily in the interesting discussions that would take place over the trolley carrying patient files, iv sets and spirit cotton. Most of the machines in this high brow institute would have been admitted for a major dysfunction, many a times life threatening (except the odd one or two admissions catering to relatives of political leaders who kept needling the consultants with their phone calls). June for the first time was playing an active role in system trouble shooting. She was a registered mechanic now, had the license to prescribe, input software programs that could eliminate system bacteria, viruses, open up blocked pipes, flush out water from the kidneys and very importantly be able to suppress the system's immune system gone awry. She had the power and ability to decide which system required what program (at least make urgent decisions at her level when her seniors or consultants weren't around).

 

79

 

 

Piercing individual universes

 

Things now were quite different from her undergraduate days, where according to the system prevailing all she did was read books and observe machines and their afflictions evolving, hardly ever needing to take responsibility for any of them. In MD residency she was responsible for the management of each of her allotted machines, beginning with daily drawing samples for analyzing system river data that would in turn reflect the functioning of each individual system component. She also had to fix input-output (I/O) devices on to the body of her systems allowing access to their rivers within. There were commercially made small and large colorful IV cannulas that helped input drugs and fluids into the systems along with gauging their central venous pressures. The latter was a larger cannula inserted in bigger veins draining nearer to the central pump, doing which was technically challenging and involved trying to scale a steep reflex learning curve. Apart from assessing central venous pressures, the machines had a lot more outputs to be analyzed like all the chemicals in its fluid firmament dazzling brightly like molecules of countless stars. The only way to really know the chemical compositions of these star constituents was to delve into system-rivers, sampling them every morning with painful needles sucking in blood and sending them to the lab in buckets full of test tubes. The laboratory physician in his observatory would take readings throughout the day from his spectroscope. These readings were from reflected light that bounce back from the stars, blood molecules collected from pierced individual universes. The residents would pounce on the evening reports as soon as they arrived neatly attaching them on to their individual system file folders ready for the evening senior residents rounds. June ran her eye quickly over the reports of bed number 16. Sodium-140Meq, potassium-4.0Meq, Creatinine-1.2mg/dl, albumin-4 g/dl...no major biochemical problems in this individual's universe, the stars winked, another bed, another universe perhaps.

Then there was sampling that involved not just collecting water from placid normal rivers, venous tributaries but also areas where there had been floods. Excess fluid in the pleural cavity (a membranous bag covering the lungs and other pipes inside the thorax) would necessitate a needle jab at the back of the chest. Similarly fluid in the peritoneal cavity (the same membranous bag covering the intestines, liver, kidneys etc) would need a poke in the abdomen. The rivers around the spinal cord generators could be accessed with the same needle devices requiring a bit more technical competence that June picked up easily, having to practice the needling art in her daily voluminous sampling efforts along with her colleagues. Some of them boasted of the ability to tap the spinal fluid by throwing needles like darts from a distance aimed at the space between the 3rd and 4rth lumbar spines on their patient’s backs. Then there were needles that could sample bits of tissues from the individual's system components. Needles biting off pieces from the liver, kidneys, pleura, peritoneum, lymph nodes, gave a valuable peep into the microcosmic battles in those individual component organs. In between her ward duties she would also be posted in the casualty where her technical skills in establishing I/O access devices would be honed further. She even learnt to effortlessly intubate machines gasping for breath, thus helping to establish a vital airway connecting patient system pipes to external mechanical lung pumping systems.

 

 

Waiting for the Mountain

 

June made friends easily, only some of them were life-long. There was Rita who shared her interest in poetry, birds and microcosmic system architecture. Their first weekend trip was to Solan in Himachal where June saw mountains unlike the rock outcrops she was used to in Sushunia. Rita told her about even loftier snow clad ones visible from Shimla, a few more miles up and how they gradually started getting bigger and bigger as you went towards them further ahead to Rikong Piyo, Kalpa in Kinnaur. June had dreamed of them earlier during her school days on listening to anecdotes at rock climbing excursions from Samsara and his climbing friends who made yearly forays into those peaks. They were average Bengali lower middle class tea cup intellectuals working in Govt offices in Kolkata but once in the mountains they became transformed into climbers, industrious and efficient in laying fixed ropes across difficult long patches.

 

June's diary, sept 01

 

There are some people who never get to see a mountain. All they can do is simply wait. Any of these days it might just happen, flapping its wings out of the blue would appear a shining desolate golden mountain and lift them off their park side benches.

 

12/9/01,

 

icu-1) Traumatic quadriparesis—Biceps brisk with fasciculations . CT Epidural hematoma compressing thecal sac. Power improved to gr 2.

ward1, Bimla's mother - PUO-sent off by me from OPD as viral…still intermittent fever spikes.

2, Ganga 20f -Lactating ,left lower zone pneumonia ,fever

12/9/01,6:30PM-Prabha Sharma 22F-Fever with hypotension-admitted yesterday -CXR-showed Lt lower zone consolidation...I added Crystalline penicillin…patient suddenly threw a seizure after having got crystalline penicillin although she was all right…just a bit restless after the attack. It was her attendants who were acting more hysterical and I had to shout at them and one point of time while I was looking for a vein to give her diazepam and her husband was muttering under his breath that we were continuing to experiment all sort of medicines on her I just blew my top. I coolly kept the injection syringe back in the table and said I won’t treat her and asked her to take her wherever he wished. That changed him completely to the reverse and he started to apologize profusely. After that we shifted her to the ICU and put in a CVP line for her hypotension.

 

The day one comes face to face with a huge mountain, automatically windows open, deep down somewhere inside the brain. Dark brown clouds atop a black massif penetrate your innermost corners and one fine day they suddenly emerge barging into a busy office room full of overworked colleagues.

 

 

 

Flying in a magic carpet

 

Residency days were flying past quickly. June was having a great time.

June's diary

Ward notes Oct 21,2001
ICU--1) Kataria---Fever persistant ?aspergillosis ...ampho available --prob--hypotension-fluids not lifting bp-Died in the evening
2) Shanta Singh76735- 91M
left ventricular failure-better--CXR-Pulmonary Edema-surprise! echo -only LVH with normal function!! 22,10,01-Last night -Restless again –6,11,01-Came back with CHB due to dig toxicity-accidental administration of 4 tabs of dig by son thinking it to be 0.125(4x.25?)

10:00 PM Came back with Rita on a rickshaw after seeing a Bollywood movie. The rickshaw puller allowed me to drive it myself on the deserted night roads much to Rita's chagrin.

I strongly believe amidst us somewhere

Resides a gigantic mountain

Full of perennial snow

Shining brightly in the afternoon sun

Changing colors with time

Morning…a pinkish white

Evening…a orange hue

We go about all our lives

Trying to scale our individual mountains

Somewhere deep within them

We exist…ourselves

 

Diary Entry made in a moving train

 

A two-day respite, from a busy workplace… Retreat…to a bird-lovers paradise…A small and sleepy hamlet in Rajasthan to which birds of all kinds of feathers flock. An intimidating distance from our Institute and yet if our feathered friends can take all the trouble to visit the place from more impressive distances, why can’t we…these are some of the thoughts which tend to comfort me while I tremble and freeze inside the Chattisgarh express as it tears its way through a chilly Uttar Pradesh country side in the middle of a winter night.

 

 

 

 

 

 

 

 

Bird billions, beeping tweeting whistling with the river-tunes

 

June’s diary

Next day I get down at Mathura. Bharatpur’s another hour ride by bus and after keeping my belongings at a relative’s place I take off in eager anticipation to meet the birds. ”To ghana …”I order the rickshaw wallah who obviously takes me for a local as it’d be unexpected for a tourist to know the name by which local people call the sanctuary. At the gate one has to deposit his/her identity card and Rs 20/- in exchange for a bicycle and I set off merrily through the road cutting across the jungle.

 

 


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Unpublished novel for all interested in the science and fantasy of medicine. Not about religion, but a postmodern multi genre combining elements of Science, Fantasy and Romance